Introduction

Everyone can be placed somewhere on an exercise continuum with the idle at one end and
the hyperactive at the other. At both extremes, health suffers. Exercise is essential to health and
managing it is the responsibility of individuals but few know what they should do. Doctors seldom
teach how to be healthy and act only when repair is needed.

The Idle

In the oceans, lakes and rivers are creatures that stay in one place and water flows over them
bringing food to their open mouths and removing waste from the opposite end of their bodies. Of all
land animals, humans are the only creatures able to exist by the same idle method. The human brain
can contrive a situation in which other humans care for idle ones and this is not about looking after
a patient in bed, it is feeding an idle person who commands others. That image, perhaps of ancient
kings, is seen by many to represent ultimate ambition; servants supplying all needs. The reality is
that the idle one is the one that suffers and those scurrying around have more benefits.
These days, physical inactivity is available to all, rich and poor and some of the poor appear to
love it. Getting food has become no more arduous than opening a packet. Ordering and paying for
it is done by pressing buttons on a smart phone and getting the money in the first place is in some
countries only a matter of getting state aid on the grounds of unemployment or being unable to
work. The more idle they are, the less they are able to work.
The consequences are obesity, diabetes and heart disease. Muscles weaken and joints are unable
to carry the added weight. Generally, idleness is accompanied by little mental stimulation which
leads to further decay of the body. Doctors are then asked to make repairs. In go the drugs, up go the
pharmaceutical profits and up go the costs to insurers and governments. Should the doctor take the
smart phone away, ban them from television and send them swimming three times a day because
swimming is less damaging to fat limbs than walking and to run is impossible? Such hardship would
help the patient and in some rare cases it is being done. Usually they get drugs and a suggestion that
they should exercise but no enforcement. This is the situation in the prosperous countries in recent
years.

The Hyperactive

In racing sports, they talk of going through the pain barrier. The margin of safety is considerable.
Grin and bear it and you will win. By that means, it was not always the strongest who won but the
person who could tolerate most suffering. When drugs became available, the pain barrier ceased to
be a barrier and the body lost its protection. The determination to win would expose the body to
excess stress that could be fatal.
I took this photograph of a bicycle hill climb in 1965. Almost certainly no performance enhancing
drugs were used. At the finish line, all the competitors were gasping for breath and some lay on their
back to recover but they were up again in a few minutes grinning and eager to find out their time.
The winner I knew well back in those days and he went on to become the National Hill Climb
Champion. He was only a year older than me and, from what I have been able to find out, he
died some years ago of a strange illness. He had suffered a crash in a race and had never properly
recovered. This, as I see it, is a danger. He had pushed himself too far, not just in physical effort but
by taking chances. It was a risk he would not ordinarily have taken but, in a race, where everything
is about winning it becomes combat.
The drugs scandals at the Olympic Games and in the Tour de France cycle race are now headline
news. Those competitors will sacrifice their lives for the vanity of winning shows the danger of sport
at this level.
Amongst amateurs, dangers abound. There are combat sports
that were encouraged because they prepare soldiers for battle. With
less hand to hand fighting in modern armies and more alternatives in
schools that are threatened by lawyers there is less boxing but rugby is
still popular especially in fee-paying schools. A young boy’s father will
tell him that the rough treatment in a game of rugby will make a man
of him. If the boy is stocky enough and determined, it is very likely he
will have a life changing injury before he is thirty. Physiotherapists and
orthopaedic surgeons specialising in joint replacements are grateful
to football, squash and tennis for the business it brings. Footballers
get kicked as well as adding pressure to their knees and hips. Racquet
games twist the knees more violently than straightforward running
with the result that a titanium implant is offered as the easy repair.
The fact that a revision (another replacement) will be needed ten to
fifteen years hence is seldom mentioned.
At the extremities of all sports there are dangers even in those that
are danger-avoidant. Rock climbing is all about fall prevention until
the glory of not using a rope takes over and then there is no backup.
Mountaineering is safe until risk taking becomes more attractive than
the scenery and the threats of bad weather, an avalanche or thaw (the
ice giving way) are pushed to one side believing that these hazards
have been overcome before. Confidence leads to invincibility, a
concept that has never been proven.
Over confidence is as much a danger as depression. The role of
exercise in combating depression with the suicides and anger that
arise are seldom appreciated. Mental health benefits from exercise as
much if not more than bodily health.
There are many activities classed as sports that do not involve
muscles and cause damage to the participants and even more so to
spectators. Motor racing is a major culprit. Deaths on the track are
less than they used to be but they instil a culture of speed which on
the public road will kill. It was often commented years ago when
people went to the cinema that after a James Bond film the cars were
hurtling away a break neck speeds with the drivers inspired by what
had enthralled them half an hour before. Motor racing is nonsense.
The winner is not the most skilful but the one prepared to take most
risk. Is that meritous? It is not even a sport.
Shooting must be equally condemned. Just as the ancient Greeks
may have delighted in wrestling and the Romans in gladiator fights,
those sports gave way to fencing and when those weapons were
superseded by guns it was shooting that was applauded. To aim, it is
necessary to be fit, so the argument goes, so that one can hold one’s
breath when firing to keep the gun steady as one breath. Does that
compare with the fitness of a swimmer or any athlete? When the
target for shooting is an innocent wild animal or bird, the claim that
this is a sport is hard to sustain.
It is a fact that most people are impressionable; they are followers
and do not question those they admire. This gives role models a
responsibility many of them do not understand. A star footballer is
seldom an intellectual. From being groomed at school to being paid to
play the game, he has learned only that what he does is right; it must
be because he is paid a lot to do it and whatever he does must be right.
He has a licence to do anything because at the extreme end of the
exercise continuum he excels. Brawn beats brain and entertainment
damages a thoughtless majority. Doctors are left to pick up the pieces.
Could they have advised so that the damage is avoided?

Figure 1

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Figure 1

The Importance of Exercise

Between the extremes of immobility and hyper-activity is where
we should be but where is it? A good observation is a report on cycling
to and from work [1]|:
Kevin Murnane writes: The effects of walking and cycling were
measured by comparing them with the Non-active mode of transport.
Cycling to work was associated with very large health benefits.
Commuters who cycled to work had a 41% lower risk of dying from
all causes than people who drove or took public transport. They also
had a 46% lower risk of developing and a 52% lower risk of dying
from cardiovascular disease, and a 45% lower risk of developing and
a 40% lower risk of dying from cancer.
This is a study of ordinary people doing what everyone does,
getting around as easily as possible. When it involves exercise, there
are great benefits - listed in the article [2]:
1. Cycling makes you happy
2. You lose weight
3. And build muscle
4. Without worrying about over eating
5. Good for the lungs
6. Cuts heart disease and risk of cancer
7. Less damage to joints
8. Saves time and money
9. Mental skill of route finding
10. Better sex
11. Better sleep
12. More brain power
13. Improved reactions and responses
14. Better immune system
15. More friends
Each one of the above would be a medical breakthrough. To get
the lot for free is astounding and true.
In richer countries in the last decade cycling has become more
popular and is said to be the new golf. For those who have always
cycled, it is flattering to be recognised as sensible and not shouted
off the road as used to happen. When the scientists investigate, they
explain what to the cyclist is obvious [3]:
Michelle Arthurs-Brennan reports that a study followed 125
long-distance cyclists. The riders are now all in their 80s but their
immune system function is similar to that of 20-year-olds.
The research, published in the Aging Cell journal, showed that the
ageing cyclists produced the same number of T-cells - which help the
immune system respond to new infections - as adults still in their 20s,
and a separate study revealed that cyclists didn’t lose muscle mass,
strength, or gain body fat in the same way as non-cyclists.
Co-author of the report, Prof Norman Lazarus of King’s College
London is 82 himself; he told the BBC: “If exercise was a pill, everyone
would be taking it. It has wide-ranging benefits for the body, the
mind, for our muscles and our immune system.”
In parallel, the same journalist presents a report on the sex lives
of female cyclists [4]:
Saddle discomfort is mentioned and the solution is a well-made
lady’s saddle of which there are many on the market. They have a
slot along the top to avoid pressure on the genitalia. Usually the nose
of the saddle is angled down for a lady whereas a man will have the
saddle horizontal. Every woman should be able to ride comfortably.
If you have a problem, a good bike shop will help you. [5] (BioFlex
O-Zone Gel Womens Saddle - Black).
The reports about Robert Marchand are incredible. He is the first
of many in his category [6].
One year after setting a new Hour Record for his age category,
centenarian cyclist Robert Marchand has decided to hang up his
wheels and retire from competitive riding at the grand old age of 106.
A multiple record holder for age-group events, Marchand has
now been advised not to take on any further competitive events on
medical grounds. He can continue cycling but should stop racing.
Read the report and note that there is nothing extraordinary
about Robert other than he is doing what others half his age could not
do. If he can do it, others can.
Born in Amiens in 1911, Marchand started riding at the age of
14, but gave up the sport only to return to cycling in 1978 aged 67.
Since then he has maintained a daily routine of riding and stretching,
eating plenty of vegetables and little meat, not smoking, and generally
avoiding alcohol.
Here is a report on a study of aging published on 6th January 2015
in The Journal of Physiology [7]:
Emeritus Professor Norman Lazarus, a member of the King’s
team and also a cyclist, said: “Inevitably, our bodies will experience
some decline with age, but staying physically active can buy you extra
years of function compared to sedentary people.
"Cycling not only keeps you mentally alert but requires the
vigorous use of many of the body’s key systems, such as your muscles,
heart and lungs which you need for maintaining health and for
reducing the risks associated with numerous diseases.”
On the 8th March 2018, Prof. Lazarus’s team published another
study in Aging Cell published by the Anatomical Society and John
Wiley & Sons Ltd. and appears to be a similar group of people, maybe
the same [8]. Study confirming old cyclists same as healthy young.
The benefits of exercise all one’s life has always been known. The
biological data is now measured in the Aging Cell report of the study
by Birmingham University [9].
Dr. Ross Pollock, who led the team of scientists from King's
College London, warned that most of us are inactive, which causes
'physiological problems at any age' [10].
Study of cyclists found they were physically younger than most their
age. Underwent extensive tests of their heart, lungs and exercise capacity.
Researchers found they had muscle strength similar to younger people.
Say it proves cycling keeps the body and the mind staying young.

Figure 2

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Figure 2

Aging and Physical Performance is Explained in the Link:

[11] Fitness and agingMind and body
If the articles referred to above suggest that all that is needed to get
all the benefits is to move muscle, think again. The mind and body are
inseparable. In a paper published last year on The Body’s Operating
System, I discussed the effect of mind on body. The interaction is also
body on mind.
The Birmingham and Kings Studies accurately report the
biological effects of exercise. It should be obvious that the same
effect will apply to runners, walkers, swimmers and all active people.
In these studies, cyclists formed a convenient group that could be
identified and measured.
Kevin Murnane’s article listing 15 benefits is correct. This includes
mental health. One cannot cycle without thinking. The machine has to
be maintained. It can fail when you are miles from home and you have
to fix it. Problem solving is where our brain excels. It distinguishes us
from other animals and has got us to the stage where we can disrupt
our environment; to solve the problems we have created.
The man repairing a puncture became the British National Hill
Climb Champion. With modern tyres and less glass on the road,
punctures are not as common as they were. We used to always repair
the puncture, not just fit a new tube, and competed to see how many
patches were on a tube before it was eventually discarded. You will see
that his friends are there to tell him what to do even though he would
do better without their distraction. This is social interaction at its best.
The group broke up as members dispersed to study and work,
married and, in some cases, died. I am still cycling and, if this article makes sense to you, am still fit and cognitively active. The
Birmingham-Kings studies required the old cyclists to be able to ride
at ten miles an hour for over six hours. Believe it or not, that is very
easy. Normal cycling speed is 14 mph and a club (chain gang) can be
doing evens (20 mph or more). For 10 mph to make the difference
between being as fit as a person 40 years younger is very interesting.
This shows that the discovery is not that exercise helps; it is that
no exercise is damaging. To exercise always all one’s life is normal.
To refer to the cyclists as a remarkable minority is to forget what we
are, animals born to forage and hunt from dawn to dusk. To feed, we
had to exert.
When people are astounded that I can ride a hundred miles (160
km) a day, I tell them it is only ten miles an hour for ten hours. If there
was more time available, I would be able to cover longer distances. It
is not a matter of strength. A normal person is well capable of these
distances. The pity is, they don’t know it.
Nevertheless, more people are discovering they have hidden
talent. Often a bicycle is daunting and they do not live where there
are quiet roads. They make go walking, Scottish dancing, swimming
or just flogging themselves in the gym.Resistance
Look at again at the photo of the puncture being repaired. This
was before most wheels had quick release hubs. He has taken the
tube out of the cover without removing the wheel to avoid getting his
hands dirty on the oily chain but he is still going to end up with the
grime of the road and aluminium oxide from the rim on his hands
and nowhere to wash them. The simple answer is to peel and eat an
orange. We were never ill.
In the summer of 1966 I cycled from Graz to Athens on unsurfaced
roads through the Balkans averaging over a hundred miles a day.
There were no plastic bottles of water for sale in shops back then.
The water bottle carried in a cage on the bike frame was topped up
at roadside wells and pumps. I never had diarrhoea and I drank a lot
cycling in the heat through Greece.
Nowadays, our exposure to germs is no less but our resistance
is far less. Go on an airline flight for a few hours and breath the air
expelled by your fellow passengers and is prepared for a sniffling cold
for a few days afterwards. These are serious dangers.
Exercise in the open air, away from cities and pollution and your
immune system improves not just from exercise but from the simple
relationship with your environment, a relationship with which we
have evolved.
India has a campaign for indoor toilets to be flushed clean by
water and proper sewage management. Outdoor defecation that
had served for centuries became impractical as population density
increased and privacy, especially for the girls and women, became
difficult. They are moving to a modern system in which chemicals will
certainly be used to solve one problem and cause others. The immune
systems will adapt maintained by exercise, sleep, diet and a balanced
approach to hygiene. We can be too careful.Sunshine
Use of gyms is growing and is to be encouraged. For a traditionalist
and outdoors man like me, a gym is hard work and uninspiring. In
some climates, extremes of hot and cold, it can be the only option. In
temperate climates the smell of fresh air, birds singing and wind in the
face is pleasure. What the scientists investigating the improvement to
the immune system did not record is the vitamin D from sunlight.
You don’t get it in a gym and the modern practice of protecting the
skin from the sun reduces the essential vitamin intake. Sunglasses
are worn too often. There appears to be a belief that they protect the
eyes. If that were true, I should be blind by now. Bright sunshine tells
the skin to beware, it changes and adds protection. People outdoors
all the time seldom have the skin cancers that attack those exposed
infrequently to unfiltered sun. In high altitude Switzerland and under
the thin skies of New Zealand and the southern hemisphere, the
conditions are dangerous and protection is essential. Under the haze
of The Gulf, sunburn is less a risk.Diet and drinks
The old cyclists who have cycled almost all their lives learned
what to eat and what to avoid. Very few smoked and that made them
outcasts in the 1950s and 60s when the majority of people smoked.
You did not need to be a scientist to see that the smoker had not got
the puff to pedal. In other words, his lungs were being damaged by
smoke. In those days, and I remember them well, almost all doctors
smoked. In their ignorance, they gave their patients bad advice.
Food was frequently discussed. We had large appetites. There was
more organic food fifty years ago and it was fresher because transport
was less efficient than today; food had to be grown locally. Knowing
what was best to eat was understood by all and we worked it out
empirically. One rider worked as a window cleaner during the week
and cycled at the weekend so he was physically active outdoors every
day in all weathers. He was our advisor and paid little attention to
books. His knowledge came from experience. He never added sugar
to his drinks or salt to his food and his explanation made sense to
all of us. There was enough carbohydrate in a balanced diet and too
much sugar meant too little roughage. Bran and the bike kept him
regular. The amount of salt added to bread was more than enough in
a temperate climate. Maybe in hot weather when sweating increased
the water through-put there is a case for additional salt and more
fluids but for the mileage we were doing, about 80 miles on a Sunday
run, no additives were needed.
We learned to not be on the road after 10 o’clock at night because
the drinkers would be driving away from the pubs drunk. It was not
illegal to be drunk driving a car. Indeed, when there was a crash, the
defence was that the alcohol made the driver incapable so it was only
an accident, not deliberate bad driving. If the driver was incapable,
he could not be blamed. Eventually this nonsense led to laws
banning drivers from drinking alcohol and there seems to be a recent
understanding amongst the general population that alcohol damages
health. Cyclists knew it many years ago and by avoiding alcohol they
have maintained good health. People have to be told. Is that the duty
of doctors?Resilience
Whether you are on a mountain ridge in the mist or miles from
anywhere on a bicycle, you have only yourself to depend on. You may
have companions and they look to you for leadership. You have no
choice but to be resilient and carry on, map reading, apportioning
your energy, not taking risks. It is all about survival. Move then to a
city job and your mental attitude goes with you. Exercise maintained
your health mentally and bodily.The role of doctors
Clinical evidence that the minority group of old cyclists have an immune system comparable to people in their twenties is proof that
the majority of people are in poor health because they do not exercise.
If a doctor’s duty is to improve people’s health, then the doctor has
to tell them to exercise and say it before the deterioration goes too
far. On the other hand, if a doctor is there only to repair the damage
however caused, the doctor can let people make mistakes through
ignorance and this will keep the doctor busy and prosperous.
Do we not argue that in an ideal world there need be no police?
By the same reasoning, doctors should not be needed if people live
properly.
Has science got us to the stage where all illness is a mistake?
Humans live and work in communities with many specialising thanks
to their education. Theoretically we can prevent all illness and injury
by education, control and prevention. For example, from the earliest
age, teach and practice the benefits of exercise. Avoid the dangers of
extremes. Control individuals by implanted chips so that everyone
is answerable to an artificial intelligence central computer thereby
eliminating the benefits of crime and war (and I would resist this being
done to me and demand that it be done to others, such is hypocrisy
and was well foretold in Brave New World by Aldous Huxley and
1984 by George Orwell). Ensure that the makers of pharmaceuticals
and machines serve the majority in the world and not just the rich.
Ebola can be controlled. Cancer is avoidable.
Guidance on these policies can only be given by those who
understand the body and mind and they are doctors. Now is the time
for doctors to work towards making themselves redundant. I am sure
that will never happen but it ought to be an objective. The police do
little to prevent crime. They advise people to lock their doors but do
nothing to change the motivation of potential burglars other than
apply threats of punishment. Similarly, doctors prescribe drugs on
top of drugs without getting to the source of a patient’s problem.
People respond to carrot, not stick.
The evidence is clear. Most people can be maintained in good
health by simply changing their lifestyle so that they exercise as
much as their bodies have evolved to do. You are a doctor so tell your
patient the blunt truth and when you say to them you don’t want to
see them again, you mean it in the friendliest way.